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Data Needs for Cardiovascular Events, Management, and Outcomes
Paul Coverdell National Acute Stroke Registry - Dr. Zhi-Jie Zheng
Zhi-Jie Zheng, MD, PhD, Cardiovascular Health Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
The Paul Coverdell National Acute Stroke Registry is a state-based program designed to measure, track, promote and improve quality of acute stroke in the United States. It is a major component of the Centers for Disease Control and Prevention (CDC)ís integrated National Heart Disease and Stroke Prevention Program. The registry was established in 2001 in honor of Senator Paul Coverdell (R, Georgia), who died of an acute stroke in 2000. Through consultations with national expert panel and after successful prototype development of eight state-based projects (GA, CA, IL, MI, MA, OH, NC, and OR) from 2001-2004, CDC funded four states (GA, IL, MA, and NC) in 2004 to implement
The scope of the Coverdell Stroke Registry program includes the process from onset of signs and symptoms through the emergency medical system or other transport to a hospital emergency department, diagnostic evaluation, use of thrombolytic therapy when indicated by diagnosis and timeliness, complication prophylaxis and management, other aspects of acute care; secondary prevention measures, and referral to rehabilitation services for surviving cases. All patients presented/transferred to the emergency department with initial signs and symptoms indicative of stroke are eligible to be enrolled in the registry initially, pending final diagnosis.
The registry utilizes web-based data collection systems that allow prospective case ascertainment with real-time data entry. A representative sample of stroke care facilities from each state are recruited to participate in the registry, and in each hospital, a minimum of 6 months of consecutive cases for a chosen timeframe are obtained. The data elements for the registry include demographic information, pre-hospital/EMS data, information on sign and symptom onset, imaging findings, thrombolytic therapy (e.g., time, complications, reasons for non-treatment), medical history, in hospital diagnostic procedures and treatment, other in-hospital complications: (e.g., DVT, pneumonia), and discharge information (e.g., ICD-9 codes, discharge destination, functional status, secondary prevention measures, and rehabilitation referral, etc).
The strengths of the Coverdell Stroke Registry include prototype-tested and standardized data elements, prospective case ascertainment, state flexibility in data system, and build-in intervention and data quality assurance. The registry, however, is not able to provide prevalence or incidence information in its current design, nor does it provide national representative sampling, and it has limited information on long-term outcomes after hospital discharge. Nevertheless, the experience learned from, and the model used for, the Coverdell Stroke Registry could be valuable for monitoring clinical management related to acute cardiac events, such as chest pain, acute myocardial infarction, acute coronary syndrome, and cardiac arrest.